Anal Fissures
Background
This is the name for literally "a pain in the behind." The pain can be experienced in the anal area or up inside the rectum. It often can feel like an even deeper pain when in the pelvic muscles, and is common in both men and women.
Diagnosing
Hemorrhoids and anal fissures
Is the pain coming from the anal area itself? If so, touching the anal area or putting a lubricated finger gently inside the anal area can elicit or reproduce the pain. When this is the case it is worth looking for hemorrhoids, anal fissures or inflammation in the rectum if the pain is reproduced by going less than an inch or two into the rectum.
Prostatitis
If the pain is coming from higher up in the rectum in a male, one can sometimes use a finger to check far up inside for the prostate. Feel for a rounded area on the front part of the rectal wall near the end of your finger when the finger is all the way in. Normally, pushing on it will cause you to feel like you have to urinate. It should, however, feel firm and not be painful. If it feels boggy when you push on it, or is painful — especially if it reproduces your pain — you may have a prostatitis as a major cause of your pelvic pain. (See Prostatitis.)
Prostadynia
If your symptoms of prostatitis do not respond to the antibiotics, your condition may be what is known as "prostadynia." This is pain in the prostate where no bacterial infection can be isolated. It may come from fungal overgrowth, constant tightening of the muscles in the pelvic region, or other unknown causes. Fortunately it often improves with the overall treatment of the fibromyalgia process. (See Prostadynia.)
STD’s
If you have a discharge from your penis (not during ejaculation — but first thing in the morning before you urinate) see your doctor and have a culture done to make sure that there is no sexually transmitted disease (STD) present.
Pelvic floor muscle pain
In females, if the pain is deeper up in the rectum, it is often coming from pelvic floor muscle pain, and can be reproduced by pushing on deep muscles during the pelvic and rectal exams. Pelvic floor pain comes from the muscles in the pelvic floor being in spasm and may even put pressure on the nerves going to the pelvis (including the vagina and bladder). The pain then causes people to tighten the pelvic muscles in response, causing an ongoing cycle of pain.
Infections
If the pain is reproduced by pushing on the cervix during a pelvic exam, your Ob-gyn will look for infections as well.
Treatments
IF YOU HAVE HEMORRHOIDS OR ANAL FISSURES:
General Diet Advice
Fiber and water
Increase fiber and water intake.
Reduce sugar and carbohydrates
The hemorrhoids or pain may also be aggravated by diarrhea or poor digestion. If the food burns as it comes out of the rectum, this often reflects malabsorption of sugars and carbohydrates. When these are not absorbed properly, the bacteria will utilize them and make acidic byproducts from them. If this is the case, one should cut back on sugar, decrease carbohydrates, and add plant based digestive enzymes.
Medications
Anusol and hydrocortisone
For hemorrhoids, it is important to treat constipation, using the over the counter medication Anusol plus hydrocortisone in cream form if pain is on the outside, or suppositories if pain is on the inside can be helpful.
Other Therapies & Advice
Moist towelettes
It is also helpful to use moist towelettes (e.g., Tucks, Cottonelle by Kleenex) instead of toilet paper when wiping after a bowel movement.
Nitroglycerin cream
If you have anal fissures, using a small amount of nitroglycerin cream (by prescription) on the area can also be very helpful. Nitroglycerin, in whatever form, can cause headaches or a drop in blood pressure — so use only the amount you need and start with a tiny amount the first time (e.g., 1/2 a pea size). These side effects usually go away with time and the dose can be increased if needed.
IF YOU HAVE PELVIC FLOOR MUSCLE PAIN:
Therapies & Advice
Relax muscles
Once one has had rectal pain, it is not uncommon for people to keep the rectal sphincter muscle very tight in response to the pain. As is the case with any muscle that is kept tight, this can lead to pain in its own right. When you are on the commode, see how far you can relax your anal/rectal and urination muscles without anything coming out. You will probably be amazed at how much extra tension is kept in these muscles. It is good to get in the habit, throughout the day, of releasing the muscles as much as you can (of course while staying continent).
Sitz baths
Symptoms can also be helped by sitting in a sitz bath. This can be made by filling your tub several inches high with comfortably warm to hot water and squatting in the water so that the warm water circulates on the anal area and soothes it and helps it to heal. Adding ½ cup of Epsom salts to the water can also help.
Additional resources
Use the S.H.I.N.E. Protocol described in this application (see S.H.I.N.E. under the "More" tab — though it focuses on fibromyalgia muscle pain, it applies to pelvic muscle pain as well). My book Pain Free 1-2-3 also has a section on pelvic pain.